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General NPI Number Information
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NPI Number | 1336175710
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Entity Type | Organization
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Legal Business Name | INVISION MEDICAL LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2610 E UNIVERSITY DR
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City | MESA
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State | AZ
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Zip | 85213-8436
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Country | US
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Telephone | 480-892-8400
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Fax | 480-890-3373
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Provider Business Mailing Address
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Address Line | 2610 E UNIVERSITY DR
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City | MESA
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State | AZ
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Zip | 85213-8436
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Country | US
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Telephone | 480-892-8400
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Fax | 480-890-3373
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVEN MICHAEL SUNDER
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Credential | OPTICIAN
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Telephone | 480-892-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 29
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1103
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1463
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 62
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License Number State | AZ
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